Department of Veterans Affairs Veterans Health Administration Roseburg VA Health Care System Fact Sheet July 26, 2011

Summary: VISN 20 and the Roseburg VA Health Care System (VA RHCS) are implementing a long-term strategy designed to improve and enhance the care delivery system in Roseburg and surrounding communities. The strategy consists of a multi-pronged approach that will enable the Roseburg VA RHCS to maintain acute-care inpatient medical and surgical capacity and enhance inpatient and outpatient services. Announcement: After careful consideration and input from Veterans, employees, and Congressional and community stakeholders, the Department of Veterans Affairs (VA) announces today that the VA Roseburg Health Care System will remain open and operational, retaining the current level of medical and surgical services. This includes a 24/7 Emergency Department, medical and surgical inpatient services extensive primary care, mental health, nursing home and residential programs. Specialty care services, including cardiology and ophthalmology, will be enhanced. VA RHCS is committed to improving access and quality of care for Veterans. Key to this goal is improving recruitment and retention of clinical staff, which will be accomplished through continued partnerships with Oregons Office of Rural Health, Mercy Medical Center and Oregons Health and Science University (OHSU) and the development of a comprehensive and aggressive marketing campaign focused on recruiting the best clinical staff possible. The facility will also expand telehealth programs in scare specialty areas and strengthen and improve current clinical and support services by sharing resources with community hospitals. VA has and will continue to invest in the VA RHCS. Currently over $55 million in approved capital investment projects are in progress, or scheduled for design or construction awards through FY 13, including: o $4.6M to construct a new Dental Clinic o $3.1M 5th floor Medical-Surgical Renovation o $4.6M Steamline replacement o $9.7M Acute Psychiatry Ward Replacement o $9.9M Protective Care Unit Relocation o $9.9M Sterilization, Processing & Distribution addition and renovation o $9.2M Mental Health Substance Abuse Residential Rehab Treatment Program Building o $1M Eagle Landing Enhanced Use Lease (EUL) o $3M Miscellaneous Non-Recurring Maintenance Projects on campus As we have throughout this process, VA is committed to including community partners, Congressional offices, Veterans groups and Veterans as we move forward with the planned improvements. 1

VA is also pleased to announce the appointment of Carol Bogedain as the new Director of the VA Roseburg. Ms. Bogedain has extensive experience in the Veterans Health Administration (VHA), to include a long tenure at the Southern Oregon Rehabilitation Center and Clinics. She most recently served as the Associate and also Acting Director of the Salem, Virginia VA Medical Center. Key Facts: The VA Roseburg will not close. The ER at the VA Roseburg will remain a 24/7 operation. VA Roseburgs ICU was closed in October 2009. Veterans have been receiving ICU care in the community and at other VISN 20 VAs in the time since without incident. VA Roseburg and Mercy Medical Center (community hospital) are finalizing a contract to formalize ICU coverage for Veterans in Roseburg. VA Roseburg will provide standard surgical services and the facility may be considered for a higher level surgery designation in the future provided the facility can establish the demand for these services and obtain the support (staff and infrastructure) required to do so. VA Roseburg has the potential to reinstate a full scale ICU if a higher level surgery designation is obtained. The telemetry unit is being remodeled at this time, and will include all requirements for the co-location of an ICU with the current patient care ward in preparation for this possibility. VA has and will continue to invest in the VA Roseburg HCS. There are currently over $55 million in approved capital investment projects in progress, or scheduled for design or construction awards, between now and FY 13. The VA Roseburg HCS has dedicated staff and strong programs in place to ensure the needs of Veterans are met. In regards to concerns about Mental Health and Women Veterans, there are currently 97 full time equivalent employees dedicated to Mental Health programs as well as a full time Womens Health Coordinator. Veterans mental health issues are a priority in VISN 20 and the VA Roseburg, as are womens health issues more broadly. Mental Health (MH) Services continue to be expanded to include the addition, in FY11, of services on Saturdays, evidence based treatment and prolonged exposure therapy, MH coverage in the ER (Monday Friday), implementation of a Veterans Justice Outreach Program and Telemental Health. VISN and Roseburg leadership have established open and productive communications with Mercy Medical Center, Oregon Health Sciences University and the Oregon Office of Rural Health to improve services to Roseburg Veterans and strengthen recruitment and retention efforts. Several promising collaborations are in process, to include shared recruitments of scarce specialty positions, credentialing Roseburg surgeons to perform selected procedures at Mercy and the sharing of ancillary services such as radiology and lab. An advisory committee, to include VISN and VA Roseburg leadership, representatives from the Portland VA and the Southern Oregon Health Care System, Mercy Medical Center, Oregon Health Sciences University, Roseburg Veterans, Congressional delegation representatives and local Veterans Service Organization members will be established and utilized as we move toward implementation. 2

Implementation Plan: The implementation plan is structured around four key themes: Service Delivery, Community Partnerships, Governance, and Recruitment and Retention of Staff. Service Delivery: The use of emerging telemedical technology is important because of its potential to (1) preserve and enhance inpatient capability; (2) enhance inpatient and outpatient capabilities by improving access to specialty services; (3) reduce the need for travel; (4) meet community desires to restore and enhance services; and (5) provide Roseburg and VISN 20 with an opportunity to be a national leader in rural health, and a model for integrated care. Telemedicine, VAMC and community partnerships offer the potential to substantially increase or enhance specialty care where it has proven to be difficult to recruit, and fill gaps when a key provider retires, relocates, or becomes ill. The telemedicine component seeks to augment existing telemedicine services already in place, to include partnering with OHSUs Department of Telemedicine, which provides services in Roseburg and other rural Oregon communities. Telemedicine is particularly important because although specialty physicians can be recruited to rural communities, it is more difficult and takes longer. Further, new hires often become dissatisfied and leave soon after being recruited. Over time, specialist capability could be enhanced, making it feasible to expand inpatient volume. We envision an upward trend built around the use of new telecommunications technologies and partnerships. Enhanced capabilities need to be implemented in a phased manner that builds capability in a deliberate fashion and allows new care venues to be thoughtfully and carefully integrated with traditional methods. At each step, progression would be predicated on laying an integrated and sustainable clinical foundation. High quality care for Veterans is the central focus of all of these efforts.

Community Partnerships: VISN 20 and the VA RHCS have reached out to state and community partners to strengthen relationships and maximize existing networks and expertise to ensure success. Response from these partners (OHSU, Oregons Office of Rural Health and community hospitals) has been positive. This is a priority of the facility and the Network office will continue to support improved communications. Roseburgs general surgeon will begin to do intermediate surgery cases in Portland to ensure maintenance of competencies. Roseburg and Portland VAMC are increasing telemedicine connectivity to provide local access to cardiology care. VA and Mercy Medical Center leadership have met and identified potential 3

partnership opportunities. Both are committed to improving care for Veterans. o Mercy will credential and privilege Roseburgs General Surgeon to enable practice also at Mercy. o Contract care is being developed with Mercy to enhance intensive care capability The Chief of Staff of VA RHCS and the CEO of Mercy have begun discussions concerning the joint-hire (recruitment) of an additional anesthesiologist and sharing of additional services. Also in progress at Roseburg: Increased ophthalmology cases began Summer 2011 Increased dental/oral surgery Increased GI endoscopy cases with the return to full clinical time by the Roseburg VA Chief of GI.

Governance: An advisory committee with representatives from VA Roseburg, the Portland VA Medical Center (PVAMC), OHSU, Veteran Service Organization, Congressional offices, and representatives from throughout the catchment area will be formed to ensure success and improve communication among stakeholders to include the opportunity for input during the decision making process. Members of the Douglas County Veterans Forum were invited to participate in the selection process of the new Director whose appointment we are announcing today and will be effective on 8/14/11. The VISN has committed to hiring additional staff to support the successful implementation of this plan.

Recruitment/Retention: The VISN has established themselves as a vendor with Oregons Office of Rural Health (ORH) physician recruitment program, which allows the VA to utilize their expertise to improve recruitment efforts. Engaging the Portland VAMC and OHSU in providing opportunities for physicians in Roseburg to practice medicine and participate in research studies on a part time basis in the Portland metro area will help address retention challenges. OHSU has proven success with this strategy and we are partnering with them in these efforts. The VISN has contracted with a national firm that specializes in recruitment marketing and corporate communications, and has extensive expertise in both private and public sector health care branding and recruitment. This is intended to strengthen recruitment and retention efforts in Roseburg.

Veterans Health Administration July 2011 4